Private Organization Accreditation

Catholic Charities alleviates human suffering and improves the quality of life of 100,000 people annually, regardless of religious background. A staff of 600 provides support and services related to housing, food, mental health, children's services, addiction treatment, and domestic violence services.


Audrey Coleman, RN-MSN

Volunteer Roles: Military Reviewer; Peer Reviewer; Team Leader

My first experience with COA was in 1999 with what was a NC Area Program. I started as a peer reviewer in 2005, doing two to four site visits a year. I am also a team leader and have recently been approved to be a military reviewer.
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Children and youth who participate in Out-of-School Time programs gain the personal, social, emotional, and educational assets needed to support healthy development, increase well-being, and facilitate a successful transition through childhood and adolescence, and into adulthood.

CA-OST 18: Health and Safety

The organization protects and promotes the health and safety of children and youth.

Note: Additional practices key to ensuring safety are addressed in other standards.  For example, CA-OST 19 addresses the importance of providing adequate supervision, and CA-OST 20.06 highlights the importance of conducting appropriate background checks.  CA-ASE and CA-BSM include additional standards that promote health and safety.  

Note: See CA-OST 11 for additional expectations when programming is specifically designed to promote health and wellness.  

Rating Indicators
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • A number of client records are missing important information  or
  • Client participation is inconsistent; or
  • One of the Fundamental Practice Standards received a rating of 3 or 4.
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing; or  
  • Two or more Fundamental Practice Standards received a rating of 3 or 4.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • A description of how the organization strives to promote the health of children and youth
    • Menus (for previous month)
    • Daily schedules (for previous month)
    • Policy and/or procedures regarding screen time (CA-OST 18.04)
    • Procedures for ensuring personnel are prepared to meet the health/mental health needs of individual children and youth (CA-OST 18.08)
    • Procedures for cleaning and sanitation, including expectations for hand washing (CA-OST 18.09, 18.11)
    • Procedures for reporting, responding to, and recording health problems and injuries (CA-OST 18.10)
    • Procedures for notifying families that their children may have been exposed to an infectious disease (CA-OST 18.10)
    • Procedures (or description) of emergency response training for children and youth (CA-OST 18.10)
    • Information provided to families (regarding health promotion and the types of food/drink that may be brought to the program)
    • Attendance guidelines that address when sick children and youth should not come to the program
    • Staff training materials addressing health- and safety-related topics 
    • Documentation that staff training on health- and safety-related topics has been provided (e.g., in training files or personnel records)
    • CPR and first aid certifications
    • Accident, injury, and illness reports 
    • Personnel records
    • Interview:
      1. Program Administrator
      2. Site Director
      3. Program Personnel
      4. Children, youth, and families
    • Review files of children and youth
    • Observe facility (indoor and outdoor)
    • Observe snack and/or meal time
    • Observe program interactions and activities

  • FP
    CA-OST 18.01

    The organization promotes healthy eating and good nutrition by serving:

    1. unsweetened beverages such as water or plain milk; and
    2. a variety of healthful and minimally-processed foods that do not contain artificial ingredients, unhealthy fats, added sugars, or high levels of sodium (e.g., fruits, vegetables, whole grains, nuts, beans, and lean meats).

    Interpretation: Personnel should make an effort to ensure that even celebrations for birthdays, holidays, and other special events feature or include healthy options.  Further, in addition to providing the types of food and drink referenced in the standard, the organization should also strive to ensure that children and youth do not have access to vending machines that offer unhealthy selections.  Personnel should ideally also consider the preferences and input of children and youth when deciding what foods to offer, to the extent possible and appropriate.

    Note:  In some cases children and youth may have special dietary needs that require accommodation.  See CA-OST 2.06, 9.06, and 18.08 for more information regarding accommodating special needs. 

    Research Note: Childhood obesity is a serious problem, and the diets of many children and youth are poor or need improvement.  Programs can take steps to combat these trends, for example by serving nutritious foods and promoting healthy eating habits.

  • FP
    CA-OST 18.02


    1. make clean and safe drinking water readily available at all times, including when children and youth are outdoors or on field trips;
    2. provide snacks and meals at appropriate times;
    3. provide children and youth with enough time to eat;
    4. offer amounts of food that are appropriate for the ages and sizes of children and youth; and
    5. support children’s and youth’s need to self-regulate the amount they eat.

    Interpretation:  Water from sinks and fountains should be tested for quality, and filtered water should be available at sites where the water quality is poor.  Children and youth should also be encouraged to drink more water in hot weather.

    Note: In some cases children and youth may have special dietary needs that require accommodation (e.g., regarding the frequency of snacks). See CA-OST 2.06, 9.06, and 18.08 for more information regarding accommodating special needs. 

  • FP
    CA-OST 18.03

    The organization supports and encourages the physical fitness of children and youth by:

    1. designing the activity schedule so that children and youth do not sit for more than one hour at a time, and incorporating short physical activity breaks into sedentary activities and transition times; and
    2. providing opportunities for children and youth to engage in physical activity for at least 30 to 60 minutes per day.

    Interpretation:  Children and youth should ideally have opportunities to engage in moderate to vigorous exercise, as well as age-appropriate bone and muscle strengthening activities.  If a program operates for a relatively brief period of time each day (e.g., for an hour or two), it may not be possible to engage children and youth in a full 30 to 60 minutes of physical activity, but at least 20 percent of program time should be set aside for physical activity (i.e. 12 minutes of a one-hour program). 
    The type of physical activity provided may vary depending on the nature of the program and the ages, abilities, and interests of participating children and youth.  For example, while an organization serving younger children might offer unstructured free play on the playground, an organization serving older children might facilitate a variety of structured activities, from dance classes, to competitive intramural sports, to walking groups.  When an organization offers opportunities for physical activity beyond unstructured free play, the organization should also complete CA-OST 11.

    Note: When programming is not designed to include opportunities for fitness, the organization should still design the activity schedule so children and youth do not sit for more than one hour at a time and incorporate physical activity into sedentary activities and transition times, and should be prepared to explain why the program’s design does not include structured time for physical activity and fitness.

    Research Note: As noted in the Research Note to CA-OST 18.01, childhood obesity is a serious problem. Regular participation in physical activity can help to counteract this epidemic, and some experts recommend that youth participate in at least 60 minutes of developmentally appropriate moderate to vigorous physical activity per day, as well as bone and muscle strengthening activities. Although out-of-school time programs may not be able to facilitate the full 60 minutes of activity time, they should strive to engage children in at least 30 minutes of exercise per day.  Further, if program participants are not engaged in physical activity at other points in their day (e.g., in gym class, or at home), the organization should strive to provide the full 60 minutes of activity time. Organizations should ideally also strive to offer a wide range of physical activity options. In addition to meeting different fitness needs, offering a variety of physical activity options will increase the likelihood that children and youth will find activities they enjoy and will pursue throughout their lives.

  • CA-OST 18.04

    The organization creates an environment that supports and encourages healthy eating and physical activity by ensuring:

    1. personnel model healthy eating and physical activity while on the job;
    2. posters, displays, and other program materials convey positive messages about healthy eating and physical activity;
    3. food and physical activity are not offered or withheld as a reward or punishment;
    4. screen time is limited; and
    5. there is adequate access to the facilities needed to support healthy eating and physical activity (e.g., kitchen, storage, and recreational facilities).

    Interpretation: Regarding element (d), children and youth should not be permitted to watch television or movies except on special occasions, and screen time that is not academic or educational should typically be limited to 30 minutes per day.  When children or youth are exercising along with a video or DVD that provides physical activity instruction (e.g., an aerobics DVD), the time does not count towards the daily screen time limits. 

    Note: See CA-OST 9.18 for more information regarding screen time and the use of technology.

  • CA-OST 18.05

    Children and youth are helped to understand the importance of developing healthy habits that support both physical and mental wellness.

    Interpretation: Children and youth should ideally be helped to understand the importance of: (1) obtaining adequate sleep, nutrition, and exercise; (2) devising healthy strategies for coping with stress; and (3) developing reasonable expectations for themselves.  It may also be helpful to explain how habits and routines in these areas may work together to impact both physical and mental well-being.  For example, moderate exercise may help to improve mood and reduce stress, and adequate sleep may improve one’s ability to manage emotions.  It may be especially relevant for organizations to provide information regarding topics that tie into their programs’ areas of focus.  For example, an organization that emphasizes academic readiness might make a concerted effort to help children and youth understand how eating healthfully, and obtaining sufficient sleep, can support readiness to learn.

    Note: While the health-related aspects of this core concept are largely focused on practices pertaining to physical health, COA does recognize the interconnectedness of physical and mental well-being, as well as the importance of focusing on the overall wellness of children and youth. Accordingly, it is important to note that other practices that contribute to overall wellness are included within other core concept standards. For example, CA-OST 5 addresses the importance of social and emotional learning, including helping children and youth understand and manage their emotions; CA-OST 4 and 5 address the importance of developing caring relationships with adults and peers; and CA-OST 4 and 9 address the importance of providing the opportunities and support that can help children and youth build skills and develop a positive self-concept.

  • CA-OST 18.06

    In an effort to support children and youth in developing and maintaining healthy habits, the organization provides families with information regarding:

    1. the importance of a healthy lifestyle, including ways to encourage healthy habits at home; and
    2. the types of food that may be brought to the program.

    Interpretation:  Information may be provided in a variety of ways, from communications at family events to materials sent to the home.  Healthy habits to encourage include those related to eating healthfully, engaging in physical activity, obtaining adequate sleep, and supporting mental wellness.  As noted in CA-OST 18.05, it may be especially relevant for organizations to provide families with information regarding topics that tie into their programs’ areas of focus.  For example, an organization that emphasizes academic readiness might make a concerted effort to help families understand how eating healthfully, and obtaining sufficient sleep, can support readiness to learn.
    When determining the types of food that may be brought to the program, it may be appropriate to consider factors related to both nutritional content and food allergies.

    Note: See CA-OST 7 for more information regarding family connections and partnerships.

  • CA-OST 18.07

    Children and youth have frequent, regular opportunities to participate in outdoor activities, weather permitting. 

    Interpretation: Children and youth should ideally have a chance to be outdoors for at least 30 minutes out of every three-hour block of time at the program.

    Note: When programming is not designed to include outdoor activities, the organization should request an NA.

  • FP
    CA-OST 18.08

    When children and youth have particular health or mental health needs, the organization:

    1. maintains information regarding needs in children and youths’ health records;
    2. specifies the role it will play in meeting those needs; and
    3. ensures that personnel are informed about children and youths’ needs and prepared to carry out any related responsibilities.

    Interpretation: Relevant health and mental health needs include, but are not limited to, needs related to: dietary restrictions, allergies, asthma, physical limitations, medication needs, and a history of trauma.

    Note:  As noted in CA-OST 2.05, relevant information regarding health and mental health needs should be collected from children and youth and their families during registration and enrollment.  When additional needs are identified during the course of program involvement, files should be updated accordingly.

    Note: See CA-OST 2.06 and 9.06 for additional expectations around assessing the needs of, and accommodating, children and youth with special needs.

  • FP
    CA-OST 18.09

    There are adequate supplies and facilities for hand washing and personnel, children, and youth are encouraged to wash hands frequently, especially before preparing food or after using the bathroom.

    Interpretation: In addition to ensuring that soap dispensers are filled regularly, the organization should also ensure that there are sanitary methods for drying hands, such as disposable paper towels or electric dryers that turn on and off automatically.  Signs or pictures should also be posted to show proper hand washing techniques and remind children of the importance of hand washing.

    COA recognizes that in some situations, such as field trips or outdoor activities, hand washing supplies and facilities (e.g., running water, soap) may not be available.  When that is the case, hand sanitizer may be an appropriate alternative.

  • FP
    CA-OST 18.10

    To protect children and youth from accidents, injuries, and illnesses, the organization ensures:

    1. personnel have access to a telephone, emergency numbers, and first aid supplies both on- and off-site;
    2. children and youth are trained in a developmentally- and age-appropriate manner on how to respond in case of emergency;
    3. families are provided with attendance guidelines that address when sick children and youth should not come to the program;
    4. procedures address when families should be notified that their children may have been exposed to an infectious disease;
    5. health problems and injuries are promptly documented, and proper health precautions are followed when supervising children and youth who are ill or injured;
    6. parents or legal guardians are notified when health or safety issues arise; and
    7. an automated external defibrillator (AED) is maintained in a well-marked, accessible location proximate to the areas where sports/fitness areas are held, as appropriate.

    Interpretation:  Please note that element (g) applies only when an organization provides sports/fitness activities as covered in CA-OST 11.  Further, while COA strongly recommends that all organizations providing sports/fitness activities maintain an AED in order to ensure proper emergency response to sudden cardiac arrest, an organization that does not maintain an AED can still demonstrate satisfactory implementation of the standard overall as long as the organization is not required by law or regulation to maintain an AED.  It is also important to note that: (1) personnel should be trained on how to use an AED, as per CA-ASE 7.04; and (2) any AED in operation should be maintained according to the manufacturer’s specification and regularly inspected, as per CA-ASE 4. 

  • FP
    CA-OST 18.11

    The organization provides an optimal learning environment that is:

    1. clean;
    2. well-lit, with natural light where possible;
    3. maintained at a safe, comfortable temperature and noise level;
    4. odor-free; and
    5. adequately ventilated.

    Interpretation: Systems for heating, cooling, and lighting should be functional, and the organization should take additional steps to facilitate a comfortable environment, as needed.  For example, floor or table lamps might be used in addition to or instead of overhead lighting, and rugs or ceiling tiles might be used to help absorb noise.

  • FP
    CA-OST 18.12

    There are no observable safety hazards in the indoor space, and materials used for indoor play are safe.

    Interpretation: Safety hazards include, but are not limited to: uncovered electrical outlets; walls, floors, furnishings, or materials in disrepair; unsecured floor coverings or furniture; harmful water temperatures; exits that are obstructed, unmarked, or poorly lit; unmarked glass doors; a lack of emergency lighting; walk-in freezers or refrigerators that do not open from the inside; unsecured windows in need of window guards; mirrors that are not shatter-proof (e.g., in hand-washing areas); hazardous materials (e.g., disinfectants) that are not properly labeled and stored securely away from children; dangerous clutter and spills; glass and other unsafe litter; stairs without railings; and unsafe use of electrical appliances such as space heaters.

    In addition, equipment, toys, and materials should meet safety requirements set forth by Health Canada, and the organization should be aware of any recalls that affect products in its programs.

  • FP
    CA-OST 18.13

    There are no observable safety hazards in the outdoor space, and equipment for active play is safe.

    Interpretation:  The organization should ensure that: the outdoor space is protected from traffic by fences or other means; entrance and exit areas are sheltered from traffic; sidewalks are free of ice, snow, and slippery mud; the space is free of glass and other litter; large equipment is bolted down; equipment is in good repair (e.g., free of rust, splinters, and loose nails or screws); swings are placed out of the way of passing children and youth; and all playground equipment is on a resilient surface (e.g., fine loose sand, wood chips, wood mulch about nine inches deep, or rubber mats). 

    Note: See the Interpretation to CA-OST 18.12 regarding compliance with requirements set forth by Health Canada.

  • FP
    CA-OST 18.14

    The organization ensures that there is at least one person certified in basic first aid and age-appropriate CPR on duty and available at all times the program is in operation, including on field trips away from the program site.

    Interpretation:  When some children will attend a field trip while others will remain on site, more than one person will need to be certified in order to meet the expectations of the standard.  Please also note that first aid and CPR certifications must be kept up-to-date according to the guidelines established by the certification body.  Certification courses with an online component are acceptable as long as they include a hands-on, in-person skills evaluation by an instructor.  Although not required by COA, organizations may also wish to have staff practise their skills between certifications (e.g., by engaging in hands-on practise with a manikin), especially if certifications are good for more than one year.  

    If law requires more personnel to be certified, COA expects the organization to meet the higher standard.  COA also: (1) encourages organizations to consider adult-child ratios, the type of activities offered, and the distance between activities when determining the number of persons who will be certified; and (2) recommends that organizations strive to have all OST personnel certified.


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